Results at one year of the TROPIS technique in the treatment of complex anal fistula

Cirugia espanola Pub Date : 2025-03-01 DOI:10.1016/j.cireng.2024.12.001

María Luisa Reyes Díaz , Fatima Hinojosa-Ramirez , Irene María Ramallo Solís , Rosa María Jiménez Rodríguez , Jose Pintor Tortolero , Ana María García Cabrera , Jorge M. Vázquez Monchul , Fernando de la Portilla de Juan

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Abstract

Introduction

It is a priority to find surgical techniques that guarantee acceptable healing rates without sequelae in the treatment of complex anal fistula. The concept of the deep intersphincteric space as the origin of perianal sepsis has provided a new perspective, allowing the emergence of techniques such as TROPIS (Transanal Opening of Intersphincteric Space), with few published series to date. The aim of this study is to evaluate the healing rate and complications one year after the TROPIS technique as a treatment for complex anal fistula without hospitalization.

Method

Prospective, observational study from January 2021 to January 2023. Patients with complex anal fistulas who met the inclusion criteria were treated using the TROPIS technique. A one-year follow up review was conducted, assessing healing rates, recurrence, continence, and complications.

Results

A total of 23 patients with cryptoglandular complex perianal fistula were included (87% male, mean age 54.7 ± 9.6 years). 78.3% were treated for recurrent fistulas with an average of 3.3 ± 3.2 previous interventions. At one month, 82.6% of the patients had complete healing. At three, six, and twelve months, complete healing occurred in 63.6%, 61.9%, and 55.6%, respectively. One patient developed an abscess at one month. Continence was altered in 8.7%.

Conclusions

The treatment of cryptoglandular complex anal fistula with this procedure was safe and showed acceptable healing rates.

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结果：TROPIS技术治疗复杂性肛瘘1年。

导言：在治疗复杂性肛瘘时，当务之急是找到能保证可接受愈合率且不留后遗症的手术技术。括约肌间隙深部是肛周败血症的起源这一概念提供了一个新的视角，使 TROPIS（经肛门括约肌间隙开放）等技术得以出现，但迄今为止发表的系列文章很少。本研究旨在评估 TROPIS 技术治疗复杂性肛瘘一年后的愈合率和并发症，无需住院。符合纳入标准的复杂性肛瘘患者接受 TROPIS 技术治疗。结果：共纳入 23 名隐腺体复杂性肛周瘘患者（87% 为男性，平均年龄（54.7 ± 9.6）岁）。78.3%的患者因复发性肛瘘接受过治疗，平均治疗次数为（3.3 ± 3.2）次。一个月后，82.6%的患者完全愈合。三个月、六个月和十二个月后，分别有 63.6%、61.9% 和 55.6% 的患者完全愈合。一名患者在一个月时出现脓肿。结论：用这种方法治疗隐腺体复杂性肛瘘是安全的，愈合率也是可以接受的。[引言：在治疗复杂性肛瘘时，当务之急是找到能保证可接受愈合率且不留后遗症的手术技术。括约肌间隙深部是肛周败血症的起源，这一概念提供了一个新的视角，使 TROPIS（经肛门打开括约肌间隙）等技术得以出现，但迄今为止发表的系列文章很少。本研究旨在评估 TROPIS 技术治疗复杂性肛瘘一年后的治愈率和并发症。方法：2021 年 1 月至 2023 年 1 月的前瞻性观察研究。对符合纳入标准的复杂性肛瘘患者采用 TROPIS 技术进行治疗。结果：共纳入 23 名隐腺体复杂性肛瘘患者（87% 为男性，平均年龄为 54.7 +/- 9.6 岁）。78.3%的患者为复发性肛瘘，之前平均接受过 3.3+/- 3.2 次治疗。一个月后，82.6%的患者完全治愈。三个月、六个月和十二个月后，分别有 63.6%、61.9% 和 55.6% 的患者完全治愈。一名患者在一个月时出现脓肿。8.7%的患者恢复了连续性：采用这种方法治疗隐腺体复杂性肛瘘是安全的，治愈率也是可以接受的。

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Cirugia espanola

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